Turkish Neurosurgery
The impact of intraoperative monitoring on extent of resection and long-term neurological outcomes: a series of 39 intramedullary ependimomas.
Mihailo Milicevic1, Domenico Solari2, Rosanda Illic1, Federico Frio2, Aleksandar Stanimirovic1, Dragan Savic 1, Teresa Somma 2, Luigi Maria Cavallo2, Danica Gruijicic1
1Clinical Center of Serbia, Clinic of Neurosurgery, Beograd,
2Università degli Studi di Napoli Federico II, Department of Neurosciences and Reproductive and Odontostomatological Sciences Division of Neurosurgery, Naples,
DOI: 10.5137/1019-5149.JTN.27471-19.2

OBJECT: The aim of this study was to analyze the impact of intraoperative neurophysiological monitoring (IONM) on extent of removal rates and long-term neurological outcomes in a series of grade II ependymomas. METHODS: We retrospectively reviewed 88 consecutives patients underwent to surgical resection of an intramedullary spinal cord tumor (IMSCT) at the Clinic of Neurosurgery of the Clinical Center of Serbia in Belgrade, between January 2012 and December 2017. 39 cases (25 males and 14 female; mean age 46.16 years) of grade II ependymomas were enrolled in the study; mean follow-up was 49.84 months. Modified McCormick Scale (mMCS) was used to assess short and long term outcomes and patients were divided in two groups in relation to the use of IONM. RESULTS: Gross-total removal rate was 89.7% and it was not influenced by use of IONM, location or tumor size. Upon admission 43.2% of patients were dependent (grades IV and V) while 56.8% were independent (grades I, II and III) according to mMCS. At 3-months follow-up 76.9% of cases preserved or improved their neurological status, this rate reduced at long-term follow-up. CONCLUSION: Total surgical resection can be achieved in the vast majority of grade II ependymomas with good neurological outcome; it’s important to underline that the use of IONM grants valid extent of resection rates providing better results in terms of functional outcomes with lesser rates of morbidity. Therefor, it was demonstrated no correlation between decrease of basal amplitudes of IONM and D-waves and poor neurological outcome.

Corresponding author : Teresa Somma